The most important initial management of a sprain is:
R - rest
I - ice
C - compression
E - elevation
Many of the problems resulting from sprains are due to blood and edema in and around the ankle. Minimizing swelling helps the ankle heal faster. The RICE regimen facilitates this.
Rest - no weight bearing for the first 24 hours after the injury (Possibly longer, depending upon severity)
Ice - apply ice packs using a towel over a plastic bag to the area that is painful. Be careful to avoid frostbite. Ice should be intermittantly applied for the first 24 hours.
Compression - an ACE bandage or other soft elastic material should be applied to the ankle to help prevent the accumulaton of edema.
Elevation - elevating the ankle helps in removing edema. By having the foot higher than the hip (or heart), gravity is used to pull edema out of the ankle.
In the initial 24 hours, it is very important to avoid things which might increase swelling:
- hot showers
- heat rubs
- hot packs
- drinking alcohol
- anti-coagulants drugs may prolong the clotting time of blood and may cause more bleeding into the ankle.
When to seek medical attention
If the ankle is obviously fractured or dislocated, then medical attention should be sought immediately. If you are fairly certain that it is sprained then use the RICE regimen and get a professional opinion regarding diagnosis and treatment. The physician will assess the severity of the injury, determine if X-rays are necessary, and will give instructions on proper rehabilitation of the injury.
In some instances a fracture of one of the bones in the leg or ankle may occur along with a sprain. Pain alone is not necessarily a reliable guide of the presence or absence of a fracture. Fractures can usually be diagnosed with an X-ray examination.
Because it is not possible to predict or discuss every possible situation that might arise, it is recommended that the patient uses common sense in dealing with his or her injury.
Degree of severity of ankkle sprains
Grade I - stretch and/or minor tear of the ligament without laxity (loosening) with little swelling and no instability. It is the most common and, if not neglected, the most minor. With a first degree injury you can expect to be back to sports within a couple of weeks.
Grade II - tear of ligament plus some laxity, the ankle usually swells immediately. There is bruising. A second-degree ankle sprain may require a 3 to 6 week rest before return to full activity.
Grade III - complete tear of the affected ligament (very loose). It requires 8 to 12 weeks for the ligaments to heal and somtimes reconstructive surgery may prevent the secondary instability.
Contributing factors:
- previous injury
- weak or inbalanced muscles
- inappropriate or worn-out shoes
- uneven surface
- overweight
Treatment
After the initial 24 hours the patient can begin partial weight bearing using crutches. Gradually progressing to full weight bearing over several days as tolerated. The patient should try to use a normal heel-toe gait. An ankle brace may be necessary to protect the joint from reinjury. As soon as pain allows, rehabilitation exercises should be done.
THE REHABILITATION EXERCISES ARE THE MOST IMPORTANT ASPECT OF RECOVERING FULL FUNCTION OF THE ANKLE.
One simple exercise that can be begun early in the course of treatment is the "alphabet" exercise. This is non weight bearing and involves trying to draw the letters of the alphabet with your toes.
Most spains heal completely within a few weeks. The more severe the injury, the longer the time to heal. Often it is necessary to continue rehab exercises for a month or two following the injury. Grade III injuries are usually managed conservatively - rehabilitation exercises, etc. - but a small percentage may require surgery.
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